Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.
Background As the rate of COVID-19 infections grew in Kisoro, Uganda, fear and misinformation about the virus were rife. Accurate, trustworthy community education seemed essential to support prevention efforts in the villages, allay widespread fear of death, and avoid the overwhelming of Kisoro District Hospital (KDH). Since 2005, KDH has collaborated with an NGO, Doctors for Global Health (DGH) and the Albert Einstein College of Medicine, NY, USA, to sponsor a robust Village Health Worker (VHW) programme in 52 villages in the Kisoro district. Community health education has been a cornerstone of the programme since its inception, and VHW-delivered home talks with portable, pictorial flip charts have shown success as a model for health education. Here, we describe a COVID-19 home-talk programme developed in a short time in response the COVID-19 pandemic and evaluate learning from this programme compared with learning from local radio (the main channel of information) and other regional information sources. In a COVID-19 lockdown, would the home-visit model be applicable? Would a health-worker delivered home-talk programme add to learning otherwise garnered from radio, television or neighbours? Methods We developed a 30 min COVID-19 home talk in 10 days; we trained 48 VHWs in an intense 2-day training, then monitored and certified VHW's skills over three sessions of field observation. Home talks were then fully implemented with a maximum of four adults per talk and social distancing was observed. To measure the retained learning from home talks, one adult per talk answered a six-item pre-test, and 3-5 weeks later, we randomly selected 20% of these participants and invited them to complete an identical post-test. To control for media exposure and assess contamination of the talk messages over time in study villages, residents of non-participating villages also completed tests at the same time that study participants completed post-tests in participating villages.
Introduction Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. The Village Health Worker (VHW) program, initiated in 2007, is an example of a long standing “horizontal” CHW program in rural Southwestern Uganda that has delivered village-level care for chronic disease based on a biannual village health census that identifies individual and family health risks. To facilitate continuity of care for problems identified, health census data were electronically transformed into family-specific Family Health Sheets (FHS) in 2016 which summarize the pertinent demographic and health data for each family, as well as health topics the family would like to learn more about. The FHS, evaluated and discussed here, serves as an epidemiologically-informed “bedside” tool to help VHWs provide longitudinal care in their villages. Methods 48 VHWs in the program completed a survey on the utility of the FHS and 24 VHWs participated in small discussion groups. Responses were analyzed using both quantitative and standard conceptual content analysis models Results 46 out of 48 VHWs reported that the FHS made them a “much better VHW.” In addition to helping target interventions in child health, women’s health, and sanitation, the FHS assisted follow-up of non-communicable diseases in the community. In discussion groups, VHWs reported that the FHS helped them understand risks for future disease, facilitated earning stipends, and increased credibility and trust in the community. Limitations cited were the infrequent updates of the FHS, only biannually with the census, and the lack of cross-reference capability by health problem. Discussion The FHS supports VHWs in providing longitudinal and comprehensive healthcare of chronic diseases in their villages. Limitations, potential solutions, and future directions are discussed.
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